Falsely increased plasma lactate concentration due to ethylene glycol poisoning in 2 dogs

Hopper, Katrina; Epstein, Steven E

doi:10.1111/j.1476-4431.2012.00825.x

Cited by 12 publications

(4 citation statements)

References 19 publications

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“…Patients suspected of ethylene glycol or propylene glycol toxicosis were excluded from analysis as this may interfere with lactate measurement on the analyzer used in this study 25 . Cases with incomplete medical records were also excluded from the study.…”

Section: Methodsmentioning

confidence: 99%

Retrospective evaluation of the prognostic utility of plasma lactate concentration and serial lactate measurements in dogs and cats presented to the emergency room (January 2012 – December 2016): 4863 cases

Saint-Pierre

Hopper

Epstein

2021

J Vet Emergen Crit Care

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Objective To determine the prognostic significance of plasma lactate concentration, plasma lactate clearance, and delta lactate in dogs and cats presented to an emergency room (ER). Design Retrospective study. Setting University teaching hospital. Animals A total of 8,321 animals with a plasma lactate concentration measured with 4,863 presenting to the ER and 1,529 dogs and 444 cats having a measurement within 4 hours of admission. Interventions None. Measurements and main results Plasma lactate concentration of dogs and cats presented to a university teaching hospital was retrospectively evaluated. Of dogs and cats with a plasma lactate concentration measured within 4 hours of admission to the ER, hyperlactatemia was common, and the prevalence of hyperlactatemia for dogs 78% (361/462) and cats 67% (78/116) was highest when evaluated within the first 30 minutes following admission. The distribution of patient's plasma lactate concentration was significantly higher in non‐survivors compared to survivors at all time points evaluated (P0.28em<0.28em$\; < \;$0.001). Both lactate clearance (P = 0.010) and delta lactate (P = 0.013) were significantly different between survivors and nonsurvivors. A delta lactate > 4.5 mmol/L was 100% (95% CI: 95 to 100%) specific for nonsurvival in patients with hyperlactatemia measured within 1 hour of admission to the ER. The most common cause of hyperlactatemia was shock in dogs (24%) and urinary tract diseases in cats (22%). Shock was associated with the highest mortality rate in both dogs (61%) and cats (77%). Hyperlactatemia was significantly associated with increased mortality for dogs with shock (P = 0.001), respiratory diseases (P = 0.022), diabetes mellitus (P = 0.018), and liver dysfunction (P = 0.006). Conclusions Hyperlactatemia was associated with mortality in both dogs and cats when measured at any time point in the 4 hours following admission to the ER. Serial lactate measurement may also be a valuable tool to guide clinical management decisions.

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Section: Methodsmentioning

confidence: 99%

Retrospective evaluation of the prognostic utility of plasma lactate concentration and serial lactate measurements in dogs and cats presented to the emergency room (January 2012 – December 2016): 4863 cases

Saint-Pierre

Hopper

Epstein

2021

J Vet Emergen Crit Care

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“…Retrospectively, the high lactic acid could be explained by the use of an ABL analyzer (ABL800 FLEX gas analyzer, Radiometer ® , Denmark), which cannot always differentiate between lactate and glycolate (an ethylene glycol metabolite) [ 12 – 14 ].…”

Section: Discussionmentioning

confidence: 99%

Rapid Diagnosis of Ethylene Glycol Poisoning by Urine Microscopy

et al. 2018

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Patient: Male, 57Final Diagnosis: Ethylene glycol poisoningSymptoms: Unconsciousness and high anion gapMedication: Bicarbonate • electrolyte correction • intravenous ethyl alcohol infusion • hemodialysisClinical Procedure: icroscopy of calcium oxalate monohydrate crystalsSpecialty: Nephrology • Intensive Care Unit • Biochemistry and ImmunologyObjective:Challenging differential diagnosisBackground:Ethylene glycol poisoning remains an important presentation to Emergency Departments. Quick diagnosis and treatment are essential to prevent renal failure and life-threating complications.Case Report:In this case report, we present a patient who was admitted unconscious to the hospital. Ethylene glycol poisoning was immediately suspected, because the patient had previously been hospitalized with similar symptoms after intake of antifreeze coolant.A urine sample was sent for microscopy and showed multiple calcium oxalate monohydrate (COM) crystals, which supported the clinical suspicion of ethylene glycol poisoning. The patient was treated with continuous intravenous ethyl alcohol infusion and hemodialysis. Two days after admission, the patient was awake and in clinical recovery.Conclusions:Demonstration of COM crystals using microscopy of a urine sample adds valuable information supporting the clinical suspicion of ethylene glycol poisoning, and may serve as an easy, quick, and cheap method that can be performed in any emergency setting.

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“…Several point-of-care analyzers using lactate oxidase amperometry erroneously measure the ethylene glycol metabolites glycolic acid and glyoxalic acid as lactate falsely reporting severe hyperlactatemia. 286,[374][375][376] Analyzers that use lactate oxidase spectrophotometry do not appear to experience the same interference. 286 In one case report describing a person with a profoundly increased D-lactate concentration (110 mmol/L [991.0 mg/dL]), positive interference by D-lactate was suspected to be the cause of erroneously reported L-hyperlactatemia.…”

Section: Analyzersmentioning

confidence: 99%

“…Ethylene glycol is another well‐recognized interferent. Several point‐of‐care analyzers using lactate oxidase amperometry erroneously measure the ethylene glycol metabolites glycolic acid and glyoxalic acid as lactate falsely reporting severe hyperlactatemia . Analyzers that use lactate oxidase spectrophotometry do not appear to experience the same interference .…”

Section: Clinical Measurementmentioning

confidence: 99%

Clinical use of plasma lactate concentration. Part 1: Physiology, pathophysiology, and measurement

Rosenstein

Tennent‐Brown

Hughes

2018

J Vet Emergen Crit Care

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Falsely increased plasma lactate concentration due to ethylene glycol poisoning in 2 dogs

Abstract: Glycolate, a toxic metabolite of EG, can interfere with the measurement of plasma lactate by some analyzers and this may delay the correct diagnosis of EG toxicity if not recognized.

Cited by 12 publications

References 19 publications

Retrospective evaluation of the prognostic utility of plasma lactate concentration and serial lactate measurements in dogs and cats presented to the emergency room (January 2012 – December 2016): 4863 cases

Retrospective evaluation of the prognostic utility of plasma lactate concentration and serial lactate measurements in dogs and cats presented to the emergency room (January 2012 – December 2016): 4863 cases

Rapid Diagnosis of Ethylene Glycol Poisoning by Urine Microscopy

Clinical use of plasma lactate concentration. Part 1: Physiology, pathophysiology, and measurement

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